Download this fact sheet: Betel nut: The effects of chewing areca nut and betel quids [PDF: 49KB]
Number FS.3 March 2006
for a general audience
Introduction
Areca, or betel, nut chewing is an important cultural practice that has traditionally been used in some medical practices, religious ceremonies and to strengthen social ties in a number of regions in south and southeast Asia and the Asia Pacific. Some people from these regions who have settled in other countries, including in Australia, have continued their cultural practice of chewing areca nut.
It is estimated that between 10 and 20 per cent of the world’s population chews areca nut in some form. This makes areca nut the fourth most widely used psychoactive substance, after nicotine, ethanol (alcohol) and caffeine.
This fact sheet provides general information about areca nut and betel quids and their effects.
What are areca nuts?
The areca nut is the seed of the fruit from a palm (Areca catchu) belonging to the Palmacae family. Some people use the nut when it is unripe and green, while others wait until it is ripe and is a brown or orange-yellow colour. The seed (or endosperm) is separated from the outer layer of the fruit and may be used fresh, dried, boiled, baked, roasted or cured.
Street/other names
Areca nut is sometimes referred to as “betel nut”. It is also known as supai, pan parag, marg, maag, pugua (Guam), suparim (Hindi and Bengali), puwak (Sri Lanka), gua (Sylheti), mak (Thailand), pinang (Sarawak) and daka (Papua New Guinea).
How are areca nuts used?
Areca nuts are chewed, in a similar manner to chewing tobacco, for their mild euphoric and stimulating effects and to help reduce tension.
The most common method of using areca nut is to slice the nut into thin strips and roll them in a betel leaf (from the Piper betle) with slaked lime (powder) or crushed sea shells. This leaf package is generally referred to as a “betel quid”, or a “betel nut chew”, “betel chew”, betel pan ( India ) or betel paan ( India ). Betel quids may also contain tobacco and other additives such as cloves, cardamom, nutmeg, aniseed, coconut, sugar, syrups and fruit extracts, to enhance the flavour. Sometimes areca nuts are rolled in leaves other than betel leaf, such as a leaf from the rubiaceous plant (Mitrogyna speciosa), nutmeg tree (Myristica fragrans), or the pepper plant used in kava (Piper methysticum).
In countries in which areca nut and betel quid chewing are indigenous, these practices have traditionally played an important role in social customs, religious practices and cultural rituals.
In some countries the areca nut can be purchased as a refined product containing a wide variety of areca mixtures, both with and without tobacco. The products that are manufactured industrially and marketed commercially are known as “pan masala”. Pan masala products that contain tobacco are generally known as gutka (India).
Effects of areca nut and betel quid
It is thought the effects of chewing areca nuts are due to several chemicals found in areca nuts, including arecoline, which affect the central and autonomic nervous systems. In betel quids, some of the effects may also be attributable to the leaves that are used.
The effects of chewing areca nut and betel quids are still not fully understood. For example, it has been claimed that chewing areca nuts and betel quids can be used to help treat parasitic infections, strengthen teeth and gums, help with symptoms of mental illness such as schizophrenia, aid digestion and as an aphrodisiac. Currently, there is little evidence to support these claims. There is still much research to be done to find out the immediate and long-term effects of chewing areca nut and betel quids and whether the suggested benefits outweigh the negative side effects.
Immediate effects
The effects of consuming areca nuts and betel quids are reportedly felt quickly, with the onset of effects occurring within a few minutes of chewing and the effects being felt for a couple of hours. The effects of chewing areca nut and betel quids appear to depend on the amount being chewed and whether the person chews areca nut and betel quids occasionally or on a regular basis. The effects are generally stronger for people who chew areca nut and betel quids occasionally than for those who chew regularly.
Areca nuts and betel quids are generally chewed for their psychoactive properties that help reduce tension, produce a feeling of well being and facilitate social interactions and strengthen social ties.
Some of the reported immediate effects of chewing areca nut and betel quids include:
- mild euphoria and a sense of well being
- feelings of general arousal and increased alertness
- palpitations and increased heart rate
- increased blood pressure
- sweating
- facial flushing and a warm sensation in the body.
There are also anecdotal reports that chewing areca nut or betel quid suppresses feelings of hunger, stimulates the appetite, aids digestion, reduces feelings of nausea and acts as an anti-diarrhoeal, although there is currently little evidence to support these claims.
People who are chewing areca nut for the first time and experienced areca nut consumers who chew a large amount may also experience:
- tremor
- dizziness
- diarrhoea
- upset stomach
- vomiting
- acute psychosis.
Long-term effects
Excessive long-term use of areca nut and betel quid has been associated with a number of health-related issues and problems such as:
- discolouration of teeth and gums, sometimes turning reddish-brown
- mouth ulcers and gum disease
- oral submucous fibrosis and oral cancers, including squamous cell carcinoma
- peptic ulceration
- increased risk of cardiovascular disease.
The risk of developing health problems increases when the betel quids include tobacco.
Social effects
Chewing areca nuts and betel quids has played a role in various cultural rituals, facilitating social interactions and strengthening social ties. However, excessive use of areca nut and betel quids can lead to a range of social problems that can impact on a person’s family, friends, work, school and financial situation. Family members and friends may become frustrated when the person does not realise the problems their areca nut chewing is causing. Some people may also spend large amounts of money buying areca nut, which can result in financial difficulties and increased pressure on the family if there is not enough money left over to buy food and other essentials.
Dependence and withdrawal
There is evidence that people develop a tolerance to areca nut and betel quids. The effects are generally stronger for people who only chew areca nuts and betel quids occasionally than for those who chew it regularly.
People who chew large amounts of areca nut and betel quids on a regular basis may become dependent on it and when they stop using it they may experience withdrawal symptoms. The withdrawal symptoms are generally mild and include:
- mood swings
- feeling uneasy, anxious, irritable, and maybe even paranoid
- poor concentration
- lack of energy
- fidgety
- sleep disturbance
- increased appetite.